title: Intraoperative intracranial pressure and cerebral perfusion pressure for predicting surgical outcome in severe traumatic brain injury.
abstract: Intraoperative intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were evaluated for use as prognostic indicators after surgery for severe traumatic brain injury (TBI), and threshold ICP and CPP values were determined to provide guidelines for patient management. This retrospective study reviewed data for 66 patients (20 females and 46 males) aged 13-83 years (average age, 48 years) who had received decompressive craniectomy and hematoma evacuation for severe TBI. The analysis of clinical characteristics included Glascow Coma Scale score, trauma mechanism, trauma severity, cerebral hemorrhage type, hematoma thickness observed on computed tomography scan, Glasgow Outcome Scale score, and mortality. Patients whose treatment included ICP monitoring had significantly better prognosis (p < 0.001) and significantly lower mortality (p = 0.016) compared to those who did not receive ICP monitoring. At all three major steps of the procedure, i.e., creation of the burr hole, evacuation of the hematoma, and closing of the wound, intraoperative ICP and CPP values significantly differed. The ICP and CPP values were also significantly associated with surgical outcome in the severe TBI patients. Between hematoma evacuation and wound closure, ICP and CPP values differed by 6.8 ± 4.5 and 6.5 ± 4.6 mmHg, respectively (mean difference, 6 mmHg). Intraoperative thresholds were 14 mmHg for ICP and 56mmH for CPP. Monitoring ICP and CPP during surgery improves management of severe TBI patients and provides an early prognostic indicator. During surgery for severe TBI, early detection of increased ICP is also crucial for enabling sufficiently early treatment to improve surgical outcome. However, further study is needed to determine the optimal intraoperative ICP and CPP thresholds before their use as subjective guidelines for managing severe TBI patients.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: teishin8@hotmail.com.
authors.forename: Tai-Hsin
authors.initials: TH
authors.lastname: Tsai
authors.forename: Tzuu-Yuan
authors.initials: TY
authors.lastname: Huang
authors.forename: Sui-Sum
authors.initials: SS
authors.lastname: Kung
authors.forename: Yu-Feng
authors.initials: YF
authors.lastname: Su
authors.forename: Shiuh-Lin
authors.initials: SL
authors.lastname: Hwang
authors.forename: Ann-Shung
authors.initials: AS
authors.lastname: Lieu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D007427:Intracranial Pressure; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: Cerebral perfusion pressure; Intracranial pressure; Severe traumatic brain injury